Inside a lab in Pisa, forensics pathologist Gino Fornaciari and his team investigate 500-year-old cold cases

Strangest of all, however, were the results of pollen analysis and immunochemical tests conducted on Cangrande’s intestines and liver. Fornaciari isolated pollen from two plants: Matricaria chamomilla and Digitalis purpurea. “Chamomile,” he told me, “was used as a sedative; Cangrande could have drunk it as a tea. But foxglove? That shouldn’t have been there.” The plant contains digoxin and digitoxine, two potent heart stimulants, which in doses like those detected in Cangrande’s body can cause cardiac arrest. During the Middle Ages and the Renaissance, foxglove was used as a poison.

In fact, the symptoms mentioned by contemporary chroniclers—diarrhea, stomach pains and fever—matched those of digoxin and digitoxine poisoning. Hence, Fornaciari concluded, Cangrande had been murdered. As it happens, a contemporary chronicler reported that a month after Cangrande’s death, one of the nobleman’s doctors had been executed by Mastino II, Cangrande’s successor, suggesting the doctor’s possible involvement in a plot to kill his master. Who ultimately was responsible for the murder remains a mystery—an assertive fellow like Cangrande had plenty of enemies—although the ambitious Mastino II himself now emerges as a prime suspect.“I thought the poisoning story was just a legend, but sometimes the legends are true,” Fornaciari says. “Paleopathology is rewriting history!”

***

Fornaciari trained as a medical doctor, and when I met him in his office at the department of oncology at the University of Pisa, he was applying his expertise to the present, peering through a microscope at samples from biopsies performed at the nearby university hospital. “I have to distinguish benign from malignant tissues,” he said, nodding to trays of samples stacked beside the microscope. “I have to be right, or there could be serious consequences for the patient—a surgeon could remove a healthy lung or breast, or leave a deadly malignancy in place.”

Now age 70, Fornaciari is an exemplar of that by now endangered species, the Italian university professor of the old school, who combines an almost fin de siècle formality with personal warmth and a disarming passion for his work. The son of factory workers in Viareggio, a coastal town near Pisa, Fornaciari earned his M.D. at the University of Pisa in 1971. He’s always been fascinated with the past, and from the outset of his medical training made forays into the health, quality of life and lifestyles of distant eras. During medical training he also took courses in archaeology and participated in excavations of prehistoric and Etruscan sites throughout Tuscany. In the early 1980s, the center of gravity of Fornaciari’s work began to shift from present to past, as he joined Vatican researchers charged with examining the remains of several prominent saints, including Pope Gregory VII and St. Anthony of Padua.

In 1984, Fornaciari agreed to lead an investigation of the most significant noble remains then to have been exhumed in Italy, the 38 naturally and artificially mummified bodies of the Aragonese royal family of Naples—major figures in the Italian Renaissance, buried in the Neapolitan basilica of San Domenico Maggiore. Fornaciari began to collaborate with scholars in Pisa and across Italy, who coalesced into an interdisciplinary team centered in Pisa. His investigators, here and in other parts of Italy, range from archaeologists to parasitologists and molecular biologists.

“Gino recognizes the fundamental importance of historical documentation and context in ways that I haven’t seen anyone else do,” says Clark Spencer Larsen of Ohio State University, a physical anthropologist who, with Fornaciari, co-directs a field project in Badia Pozzeveri, a medieval monastery and cemetery near Lucca. “He’s knowledgeable in many other areas as well. He’s pragmatic and interested in whatever answers the question, ‘How are we going to figure this out?’”

By now, Fornaciari had become the go-to guy for old bones in Italy, and was tackling an ever-growing range of centuries-old corpses, including an entire community overwhelmed by the Black Plague in Sardinia, and a cache of 18th- and 19th-century mummies in an underground crypt in northeastern Sicily. Then, in 2002, he and his team struck the mother lode of paleopathology when they were invited by the Italian minister of culture to investigate the 49 graves in the Medici Chapels in Florence, one of the most significant exhumation projects ever undertaken. Fornaciari still leads the ongoing investigation.

***

Recently, I drove out to visit his main paleopathology laboratory, established by the University of Pisa with a grant from the Italian Ministry of Research Institute. The structure is housed in a former medieval monastery, set on a hillside ringed by olive trees east of Pisa. When we arrive, a half-dozen researchers in lab coats are measuring human bones on marble tabletops, victims of a virulent cholera epidemic that ravaged Tuscany in 1854 and 1855, and entering anatomical data into a computer database. At another counter, two undergraduates apply glue to piece together the bones of medieval peasants from a cemetery near Lucca.

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